Important reminders for Healthy Blue Outcomes^SM patients

Blue Cross Blue Shield of Michigan’s outcomes-based PPO, Healthy Blue Outcomes, ties a financial incentive to positive behavioral outcomes. You may have patients with this coverage, so below are some helpful reminders about the Healthy Blue Outcomes program:

• Under Healthy Blue Outcomes, a patient must complete the online health assessment and meet with a physician to complete the Qualification Form within 90 calendar days of his or her benefit effective date.

  Note: BCBSM and Blue Care Network use different qualification forms. BCBSM does not reimburse health care providers for completion of the Qualification Form.

• If a member has a medical condition that makes it unreasonably difficult or inadvisable to meet the health requirements, his or her physician may request a medical waiver.

  The Medical Waiver (PDF) request form is separate from the Qualification Form and can be downloaded from web-DENIS or bcbsm.com.

  You can complete the Medical Waiver request form along with the Qualification Form during the member’s preventive care medical exam. Be sure to sign the Medical Waiver request form, and instruct your patient to fax it to the number listed on the form within 120 days of his or her benefit effective date. When you complete the waiver, make sure to complete the member health improvement plan with your patient, too.

  The Medical Waiver request form can be used to ask for a waiver of all requirements for members who are in hospice. The member’s authorized representative can call the Engagement Center to ask for an override, too.

• Please remember to use in-network independent laboratories or other facilities for analysis of patient lab work.

• As of Oct. 1, 2011, you must administer a cotinine test for Healthy Blue Outcomes members to determine whether they use tobacco.

  One cotinine test per member each calendar year is covered 100 percent when performed by an in-network physician and billed with the appropriate procedure codes below. Acceptable testing methods include either a urine test or a serum test.

  Note: If a member is using a smoking cessation method, he or she should inform you during the initial office visit. The test value doesn’t need to be recorded on the Qualification Form.

  Here are the appropriate procedure and diagnosis codes to use when submitting claims to BCBSM for this test:

  Procedure codes

  • *80101: Payable with any of the diagnosis codes below.
  • *83887: There are no diagnosis restrictions for this code.
  • G0434: Payable with any of the diagnosis codes below.

  Diagnosis codes

  • 989.84: Toxic effect of tobacco (non-tobacco users)
  • V15.82: Personal history of tobacco use, presenting hazards to health (tobacco users)
  • 305.1: Nondependent tobacco use disorder
  • V70.3: Other medical examination for administrative purposes

If you have any questions, contact your provider consultant for more information.